用肺组织瓣重建胸段气管的动物实验与临床应用

目的 探讨用肺组织瓣重建胸段气管的可行性。方法 健康犬15只,切除其长6～8个气管软骨环、周径1／2以上的气管前、后壁,内置镍钛合金网架。游离邻近带血管蒂的肺组织瓣,缝合修补气管壁之缺损。分别于术后2～12个月处死动物,观察气管缺损部位的修复情况,并取材行光学显微镜及电镜检察。临床上用此方法治疗4例患者,其中1例右主支气管因瘢痕狭窄闭锁,1例主气管下段混合瘤恶变,2例左主支气管类癌。结果 实验犬呼吸道通畅、无狭窄及肉芽组织形成,用于修复的肺组织瓣和金属网架表面覆盖有较完整的假复层纤毛柱状上皮。临床治疗的4例患者,均顺利恢复正常呼吸功能,随访疗效稳定。结论 肺组织瓣是较理想的胸段气管重建材料。

Clinical application and animal experiment of thoracic tracheal reconstruction by using pulmonary tissue flap

Objective To study the usability of pulmonary tissue flap in the reconstruction of the thoracic trachea. Methods Over half perimeter anterior and posterior wall and 6 to 8 tracheal cartilagious rings of dog trachea were resected. The nickel-titanium alloy mesh stent was placed inside the lumen for repair of the defect of the tracheal wall by nearby pulmonary tissue flap with the vascularized segment. The dogs were killed from 2 months to 12 months after operation. Specimens were taken and observed under light and electron microscope. Clinically, 4 patients were treated by this way operation right common tracheal scarred stenosis and atresia(1), mixed cancerization in the lower part of the common trachea(1) and left common tracheal carcinoid(2)]. Results No stenosis and granulation tissue were observed in the prosthetic lumen, in which there was comparative continuous stratified ciliated columnar epithelium. All patients recovered respiratory function. Conclusion Pulmonary tissue flap is a promising prosthesis of thoracic tracheal reconstruction.